'Romneycare,' meet 'Obamacare'

It’s something supporters of President Barack Obama’s health reform law will say again and again: The health care overhaul put into place in Massachusetts by Mitt Romney is the big (but smaller) sister of the federal law. His rivals for the Republican presidential nomination like to say it, too.

But that doesn’t mean Romney’s law gets to stay just like it was just because it got there first. It still has to conform to the federal law, and that won’t exactly be an easy lift.

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That’s right — even “Romneycare” can’t escape “Obamacare.”

States have until 2014 to set up their exchanges; that’s when the law fully kicks in. Massachusetts already has many key pieces of the law in place: a fully functioning exchange, an individual mandate, a ban on discriminating against people with pre-existing conditions and tax subsidies to help people pay for insurance. And yes, the state law was the model for national reform.

So “Romneycare” is already pretty much the same as “Obamacare,” right? Sure — except for all the things that are different.

Observers of the Massachusetts law say while technological support and the political will is there, there are still some big pieces that might have to change — from the state-run program for low-income people to the different (and bigger) fines Massachusetts charges for people who don’t get health insurance.

There are a lot of other details that might have to be tweaked, and over the next two years the policymakers in the state will have to look at all of them.

“I am confident we will get there,” said Glen Shor, executive director of the Massachusetts health insurance exchange, called the Health Connector. “We have a great foundation to work off of, and we will be very busy in the coming weeks and months. But I am very confident we will get there.”

It’ll be the job of Shor and his board to make behind-the-scenes decisions and adjustments to bring the state’s exchange up to snuff. Simultaneously, Gov. Deval Patrick has committed to passing legislation to get health care costs under control. That’s a priority of his, given that costs have continued to rise since the health law went into effect in 2006.